Intraventricular hemorrhage in very low birth weight infants. Associated risk factors in Isfahan, Iran

OBJECTIVE: Prematurely born infants with intraventricular hemorrhage (IVH) suffer significant morbidity and mortality, particularly those infants with high-grade hemorrhage. Previous studies have proposed a number of risk factors for IVH; however, lack of adequate matching for gestational age and birth weight may have confounded the results. The purpose of this study was to identify variables that affect the risk of IVH.

METHODS: We identified 31 preterm infants with gestational age <32 weeks and birth weight <1500 g, with IVH, from November 2003 to January 2005 at Alzahra University Hospital, Isfahan, Iran. A control group of 90 infants, matched for gestational age and birth weight was selected. Maternal factors, labor and delivery characteristics and neonatal parameters were colleted in both groups. Results of cranial ultrasound examinations were also collected.

RESULTS: The significant risk factors for IVH were found to be: patent ductus arteriosus (PDA) [4 (13.3%) versus 3 (3.3%) (p=0.01)], longer duration of assisted ventilation [2.8 ± 5.8 days versus 0.5 ± 2.1 days (p=0.002)], higher number of endotracheal suctioning [9.7 ± 18.4 versus 3.06 ± 13.7 (p=0.004)], surfactant use, [7 (22.6%) versus 3 (3.4%) (p=0.003)], positive pressure ventilation at birth [(12 (38.7%) versus 12 (13.3%), (p=0.004)] and low Apgar score at 1 and 5 minutes. Whereas antenatal steroid treatments and cesarean section have a protective effect on the occurrence of IVH.

CONCLUSION: Our data emphasize the importance of obstetric and perinatal care to improve outcomes of premature infants.